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<br />EVANSTON INSURANCE COMPANY <br />CERTIFICATE NO.: - <br /> CERTIFICATE OF INSURANCE <br />EXCLUDES COVERAGE FOR NOMINEE EVENTS. SEE SEPARATE APPLICATIONS FOR NOMINEE EVENTS. <br /> SPECIAL EVENT LIABILITY PROGRAM <br />PRODUCER: PUBLIC ENTITY (ADDITIONAL INSURED) <br />Driver AIliant Insurance Services Cily 06 Santa AM <br />P. O. Box 28323 20 C,¿V-ic. CelLteA Pl.a.za, M-28 <br />Santa Ana, CA 92799-8323 Santa AM, CA 92701 <br />(949) 660-8163 <br />License No: OC 36861 <br />NAMED INSURED (EVENT HOlDER): EVENT INFORMATION: <br />RÙhalLd GltegeA TYPE: Inðbutc.üonlLt - Se1.-,í ImPltoveme~ <br />17561 BltelLt Lane DATE(S): 10/8/04 - 12/31/04 <br />TU-6un, CA 92780 . LOCATION: W.O.R.K. CPILtPlt <br />This is to certify that the policies of insurance listed below have been issued to the insured named above for the policy period <br />indiCated, Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this <br />certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, <br /> <br />e I 'ns <br /> <br />d <br /> <br />nditio <br /> <br />ofs ch <br /> <br />I'c' <br /> <br />L' 'ts h wn <br /> <br />hav be <br /> <br />r d <br /> <br />d by pad laims <br /> <br />XC USIO an co ns u PO] les. llTIl S 0 may e en e nee 1 C <br />INSURANCE CARRIER: Evanston Insurance Company <br />MASTER POLICY NUMBER: 04SEPIOOOOOI <br />MASTER POLICY DATES: EFFECTIVE: JANUARY 1,2004 EXPIRATION: JANUARY 1,2005 <br />COMMERCIAL GENERAL LIABIUTY OCCURRENCE FORM DEDUCTIBLE: NONE <br />General Aggregate Umit $ 2,000,000 <br />Products & Completed Operations 1,000.000 <br />Personal & Advertising Injury 1,000,000 <br />Eacb Occurrence Limit 1,000,000 <br />Fire Damage (Any One Fire) 50,000 <br />Medical Payments (Any One Person) 5,000 <br />The limits of insurance apply separately to each event insured by this po1icy as jf a separate policy of insurance has been issued for that event. <br />"Who is insured" is amended to include, as an insured. the person or organization shown in this schedule, hut only with respect to liability arising out of the <br />ownership, maintenance or use of the premises used by the named insured (event holder). This insurance does not awly to: Any "occurrence" which takes place <br />after the event holder ceases to be a tenant in that premises. <br /> OTIIER ADDITIONAL INSUREDS <br />,J.j¡-'..J.--,',DU I,,) , ß r"VKJYl <br />~----- <br /> I' -,' ,',.. ' <br /> :~¡-.Jd ",.d .J".:."eJy <br /> '. , <br /> '. <br />CANCELLA nON: Should the above descnòed policy to cancelled before the expiration date thereof, the issuing company wjll mail 30 days written notice to the <br />certificate holder and additional insureds listed. <br />AurnORmIDRE"""ENTATIVE ~~ <br />DATE ISSUED: Oc;tobelt 8, 2004 <br /> .' (,C <br /> , <br />